Elective high frequency oscillatory ventilation versus conventional mechanical ventilation on the chronic lung disease or death in preterm infants administered surfactant: a systematic review and meta-analysis

Background: Use of elective high frequency oscillatory ventilation (HFOV) compared with conventional mechanical ventilation (CMV) results in a small reduction in the risk of chronic lung disease (CLD) or death, but the evidence is weak. Our objective was to explore whether elective HFOV was associated with less CLD or death as compared with CMV in preterm infants administered surfactant. Methods: We conducted a systematic review and meta-analysis, including 1835 ventilated participants from 11 randomized controlled trials comparing elective HFOV with CMV between February 1993 and February 2014. The primary outcome was the incidence of CLD or death. Results: Compared with CMV, elective HFOV was associated with less CLD or death (relative risk (RR) 0.76, 95% confidence interval (CI) 0.61-0.94, p = 0.01) (p = 0.01, I-2 = 55%), CLD (RR 0.71, 95%CI 0.53-0.93, p = 0.01) (p = 0.03, I-2 = 50%), and >= 2nd stages of retinopathy of prematurity (RR 0.77, 95%CI 0.62-0.94, p = 0.01) (p = 0.42, I-2 = 0%). In the subgroup of > 1 dose of surfactant, compared with CMV, elective HFOV was also related to less CLD or death (RR 0.87, 95%CI 0.77-0.98, p = 0.02) (p = 0.10, I-2 = 42%). No differences were found in the incidences of death, grade 3 or 4 of intraventricular hemorrhage, periventricular leukomalacia, airleak and necrotizing enterocolitis between the two groups. Conclusion: Elective HFOV is superior to CMV in reducing the incidence of CLD or death in ventilated preterm infants administered surfactant, especially in the subgroup of >1 dose of surfactant. Trial registry: International Prospective Register of Systematic Reviews: No.: CRD42022301033; URL: https://www.crd.york.ac.uk/PROSPERO/.